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Primary Submission Category: Socioeconomic status
The relationship between individual indicators of socioeconomic status and community-level social determinants of health as predictors of obstetric interventions: a multi-level intersectional latent class analysis
Authors: Regan Moss, Dovile Vilda, Elizabeth Sutton, Kelli Hall,
Presenting Author: Regan Moss*
Background: Obstetric interventions (including induction of labor (IOL) and cesarean delivery) are increasingly common in the United States, even among low-risk pregnancies. While clinical factors explain some of this variation, non-clinical determinants such as individual socioeconomic characteristics and community-level conditions, are underexamined. We apply a multi-level intersectional framework to identify how combined social and structural exposures predict obstetric intervention use in Louisiana.
Methods: We will conduct a cross-sectional analysis of hospital records data on singleton live births in Louisiana from 2015-2022. Using latent class analysis, we will identify latent classes of combined individual- (e.g., education level, employment status, primary insurance, insurance type) and community-level (e.g., distance to care, percent of population that is uninsured, median gross rent, population density, percentage of housing units vacant, social vulnerability index, minority social vulnerability index, segregation index) social determinants of health and estimate their association with induction of labor and cesarean delivery, controlling for clinical indications and obstetric history.
Results: Preliminary analyses indicate that among 59,191deliveries, 37.10% of the full sample was Black and 50.10% were White. 27.92% was college-educated; 21.97 were high school-educated. 29.88% was employed full time and 41.88% were not employed. 47.05% were insured through Medicaid and 52.22 through private insurers.
Discussion: Using an intersectional multilevel approach, this study examines how overlapping social and structural exposures contribute to obstetric intervention use beyond what clinical factors alone explain. Findings are expected to illuminate structural and institutional drivers of medicalized birth, with implications for maternity care policy and future research on non-clinical contributors to rising intervention rates in the US.